nib pre-approval: when to get it and what to send
nib recommends rather than requires pre-approval, which sounds like the softer option and is not. Approval is what turns an estimate into a written statement of what you are covered for, and it is what lets a provider invoice nib directly instead of invoicing you.
Getting pre-approval from nib
- Skip it for everyday care. nib says pre-approval is not needed for everyday healthcare such as GP visits, dental treatment, new glasses or prescriptions. Check the policy in my nib for whether those are covered.
- Get it for anything outpatient or hospital. nib says it is a good idea for outpatient and hospital consultations and treatment: seeing a specialist, diagnostic investigations, surgery, cancer treatment or non-PHARMAC drugs. Some providers want to see the pre-approval letter before treating you.
- Ask your provider to do it. Some First Choice network providers will submit the request for you. If yours will not, or is outside the network, you request it yourself in my nib.
- Have the four documents ready. nib asks for scans or photos of your referral letter or medical report, the registered specialist consultation letter if there is one, the ACC decision letter if there is one, and a quote or supporting document from a recognised provider showing the total estimated cost.
- Flag it if treatment is within five days. nib has a separate path for a procedure that is urgent and taking place within five days. nib confirms the outcome by phone or email, and progress is visible in my nib.
What nib publishes
| Fact | What the insurer publishes |
|---|---|
| Status | Recommended, not required. nib strongly recommends it for surgical claims and claims over $1,000 read 2026-09-09 |
| Not needed for | GP visits, dental treatment, new glasses, prescriptions read 2026-09-09 |
| Recommended for | Specialist consultations, diagnostic investigations, surgery, cancer treatment, non-PHARMAC drugs read 2026-09-09 |
| Documents to have ready | Referral or medical report; specialist consultation letter; ACC decision letter; a quote showing total estimated cost read 2026-09-09 |
| How you hear back | By phone or email, with progress visible in my nib read 2026-09-09 |
| Published approval turnaround | Not published |
| On the QuoteHub panel | Yes. We can place and service this cover, so we can help with a claim on a policy we arranged. |
Questions about nib pre-approval
How long does nib pre-approval take?
nib does not publish a timeframe. It commits to confirming the outcome by phone or email and to showing progress in my nib, but no number. UniMed is the only one of the three that publishes one: three working days from receiving everything, up to five.
If pre-approval is only recommended, can I skip it?
You can, and for small everyday costs it makes no difference. For surgery it removes the two things approval gives you: written confirmation of what is covered before you commit, and the ability for the provider to invoice nib directly rather than you paying and claiming back.
What if my specialist is not in the First Choice network?
You can still be pre-approved, but the amount changes. nib pays the Efficient Market Price for a recognised provider outside the network, so approval will confirm cover at that level, not at whatever the specialist charges. Ask what the gap is before you book.
Does an ACC decision affect it?
It can, which is why nib lists the ACC decision letter among the documents to attach. Where ACC accepts a claim, ACC is the first payer, and the health policy addresses what sits outside that. Sending the decision letter up front avoids the request coming back for it.
Where these facts came from
- Health Insurance Claim, How To Claim, nib, read 2026-09-09
- How do I get my treatment costs pre-approved, nib, read 2026-09-09
Where to go next
- nib nz: cover, ratings and documents
- How to claim on nib health insurance
- Every health insurer we compare
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